Is high sodium intake associated with hearing impairment? The
association between spot urine sodium concentration and
hearing threshold in Korean adolescents

Abstract:Background and Objectives: High sodium intake is a well-known risk factor for diseases
such as cardiovascular and renal disease. There may also be links between sodium intake
and inner ear symptoms. However, the available data are limited, and clinicians remain
suspicious about sodium intake and hearing threshold. We analyzed the relationship
between spot urine sodium concentration and sensorineural hearing loss in Korean
adolescents. Methods and Study Design: A total of 534 subjects, aged 12–19 years old,
were enrolled in this study. Sex, age, hearing threshold, and overnight spot urine sodium
concentration were measured. Multivariate logistic regression analysis was performed to
estimate the independent effect of sodium intake on hearing level. Results: Higher urine
sodium concentrations were observed in subjects with hearing impairment in 2000, 3000
and 4000 Hz. After adjusting for sex, age and BMI, we found an association between urine
sodium concentration and sensorineural hearing loss in 500, 2000, 3000 and 4000 Hz.
Conclusion: Our results suggest that high sodium intake might be associated with hearing
impairment.

Abstract:Background and Objectives: Severe infection, inadequate food intake, and pressure
ulcers in patients with type 2 diabetes can result in malnutrition. We describe a case in
which rehabilitation nutrition was effective for treating a pressure ulcer in a malnourished
patient with type 2 diabetes. Methods and Results: A 58-year-old man with type 2
diabetes was diagnosed with hidradenitis suppurativa on the left buttock and thigh and a
severe pressure ulcer on his left kneecap. Malnutrition was related to hypermetabolism
caused by chronic hidradenitis suppurativa and inadequate protein-energy intake before
admission. We initiated a rehabilitation nutrition intervention to improve physical function
and to treat a pressure ulcer by prescribing 2,000 kcal/day of food, including 80 g of
protein, and physical rehabilitation for 40 minutes/day. The patient showed good progress
in terms of his physical function and healing of the pressure ulcer. After prescribing 2,250
kcal/day of food, including 85 g of protein, and physical rehabilitation for 60 minutes/day,
HbA1c levels increased to 7.4%. The energy prescription was decreased to 2,000 kcal/day
to improve glycemic levels. Then, the patient’s weight decreased and his hand grip
strength became weaker. On day 134 and discharge the patient could walk independently
with a t-cane and ankle supporter. By day 14 after discharge, the pressure ulcer had
epithelialized. Conclusion: Rehabilitation nutrition management improved physical
function and facilitated pressure ulcer healing in a malnourished patient with type 2
diabetes. Close conjoint management of hyperglycemia was also necessary.

Taste sensitivities and diet of Chinese and Indians in Singapore

Author:Claudia Leong Shu-Fen

Keywords:diet, human health, Chinese, Indian, taste

Abstract:Background and Objectives: Taste perception plays a key role in consumer acceptance
and food choice, which has an important impact on human health. Our aim was to examine
the relationship between recognition thresholds for five basic tastes (sweet, salty, sour,
bitter, and umami) in Chinese and Indians in relation to their dietary intake. Methods and
Study Design: This cross-sectional study included 114 subjects (60 Chinese, 54 Indians).
Taste thresholds were determined using a forced choice method and dietary intakes were
assessed using an estimated three-day food diary. Results: Indians had significantly higher
recognition thresholds for sweet, salty, sour, umami and bitter tastes compared to Chinese
(all p0.047). Overall energy intake was not significantly different between the Chinese
and Indians. Correlations between taste and diet between the Chinese and Indians were not
significant (p>0.05). Conclusion: Future work is needed to further understand how
differences in taste perception may influence dietary intakes between ethnic groups.

Abstract:Background and Objectives: Nutrition and inflammation play a crucial role in the development of cancer. The prognostic value of the prognostic nutritional index (PNI) has been confirmed in some types of human cancers. This study analyzed the prognostic significance of the preoperative PNI in patients with stage III gastric cancer after curative surgery. Methods and Study Design: In this retrospective study, we enrolled 274 patients who underwent curative operation for stage III gastric cancer. The correlation between the preoperative PNI and overall survival (OS) was analyzed using Kaplan–Meier curves and multivariate Cox regression analyses. Results: The patients with a high PNI had a significantly higher median OS than did those with a low PNI (46.83 months vs 24.13 months, p=0.010). In the subgroup analysis, the survival benefit of the PNI was limited to the patients with poorly differentiated gastric cancer (high PNI, 46.83 months; low PNI, 21.77 months, p=0.004) and was not observed in those with well and moderately differentiated cancer (high PNI, 30.30 months; low PNI, 26.67 months, p=0.296). In the multivariate analysis, the PNI was an independent prognostic factor for OS. Conclusions: The PNI can be used as an independent prognostic biomarker for operable advanced gastric cancer.

Abstract:Background and Objectives: Despite growing interest in the association between dietary
amino acid intake and optimal health, validated dietary questionnaires that can estimate
amino acid intake have been scarce. We examined the validity of amino acid intakes
estimated using a self-administered diet history questionnaire (DHQ) comparing with 16-day
semi-weighed dietary records (DR). Methods and Study Design: A total of 184 Japanese
men and women completed a four-day DR and a DHQ four times, once in each season.
Dietary amino acid intakes were estimated as crude, energy-adjusted, and percentage of total
protein intake (% protein) using an amino acid database of Japanese foods. The validity of
dietary amino acid intake estimated by the first-time DHQ was examined using the mean of
16 days’ DRs as reference. Results: Mean intakes of almost all amino acids estimated by
DHQ were significantly lower than those estimated by the DR for energy-adjusted values in
both sexes. Although mean amino acid intakes estimated by DHQ were significantly higher
than those estimated by the DR for % protein value, the differences between the DR and
DHQ were slight (-0.04 to 0.39% protein for men, -0.05 to 0.37% protein for women).
Pearson correlation coefficients between DHQ and the DR showed reasonable ranking ability
in % protein values for men (interquartile range (Q1-Q3): 0.31-0.47) and energy-adjusted
values for women (interquartile range (Q1-Q3): 0.40-0.45). Conclusion: DHQ showed
acceptable ability to estimate mean amino acid intake and to rank individuals in a population
according to their amino acid intake for using in large-scale epidemiological studies.

Identifying errors in meals provided to and sourced by patients on
therapeutic diets in hospital

Abstract:Background and Objectives: Patients requiring therapeutic diets in hospital are at risk of
exposer to dietary errors that may pose an acute threat to their safety. This study aimed to
determine the prevalence of meal-related errors among hospitalised patients prescribed
therapeutic diets, following the implementation of an electronic foodservice system (EFS).
Methods and Study Design: This observational study involved six wards in a tertiary
metropolitan hospital that used an EFS for meal ordering and plating. Participants were adult
medical inpatients receiving a therapeutic diet for medical or nutritional reasons. Meal accuracy
was assessed for up to 48-hours per patient by comparing the dietary items placed on patients’
meal trays or personal meals consumed by patients to their therapeutic diet prescription.
Inaccuracies were categorised as critical or non-critical errors and were identified as having
occurred at one of four steps in the EFS: menu planning (main-meals), meal assembly
(main-meals), meal delivery (mid- and main-meals) and meal consumption (personal-meals).
Results: A total of 167 inpatients were included in the study. Of the 906 meals assessed, 69
errors (8%) were observed; with 97% classified as critical. Error rates differed according to the
foodservice system step assessed: 17% for menu planning, <1% for meal assembly, 53% for meal
delivery: main-meals, 9% for meal delivery: mid-meals and 33% meal consumption.
Conclusion: An EFS almost completely eliminated errors associated with meal assembly.
However, when foodservice staff and patients selected dietary items at ward level (without a
guiding system) a substantial number of potentially critical errors occurred.

Age and CD4 count are dominant factors in the prediction of
anaemia in Javanese HIV patients

Author:Joko Wahyuwibowo

Keywords:age, CD4, anaemia, HIV, Javanese

Abstract:Background and Objectives: Anaemia in Human Immunodeficiency Virus (HIV)
infection is multifactorial and an increasingly important variable to consider in the
management. This is the first study of anaemia in HIV infection in the Javanese population,
which constitutes the largest ethnic group in Indonesia. The aim of this study was to
determine the factors which are associated with anaemia in Javanese patients with HIV
infection. Methods and Study Design: This study applied a cross-sectional design
involving HIV patients in Dr. Kariadi Hospital and Balai Kesehatan Paru Masyarakat
(BKPM), Semarang, Indonesia. The characteristic data of the subjects were age, gender,
BMI, duration of therapy and antiretroviral (ARV) drugs. Haematology tests were
conducted using flow cytometry. Results: The prevalence of anaemia in HIV-infected
patients was 21 (38.88%). Macrocytic anemia was found as a majority (12; 57.1 %) in
anaemic patients. The risk factors which were found to be associated with increase of
anaemia were white blood cells (WBC) <5.0 x 109/L and CD4 <200.0 cells/µL (p<0.05). A
correlation between anaemia and age (r=0.49, p<0.01), duration of treatment (r=0.35,
p<0.01), CD4 count (r=-0.42, p<0.01), total bilirubin (r=-0.28, p<0.05), and unconjugated
bilirubin (r=-0.29, p<0.05) was identified. Age (p=0.023) and CD4 count (p=0.07) were
the dominant factors in the multivariate analysis. Conclusion: Age and CD4 count are the
dominant factors in determining of anaemia in Javanese patients with HIV infection.

Abstract:Background and Objectives: Iron deficiency is the most common cause of anemia
worldwide. In Southeast Asia, studies showed that genetic hemoglobin disorders also
contribute significantly to the burden of anemia. The study aimed to estimate the
proportion of thalassemia and other hemoglobinopathies versus iron deficiency and other
causes in a sample of anemic individuals; describe the characteristics of thalassemic
subjects in terms of severity of anemia, adequacy of iron stores, and hematological profile;
examine the intake of iron supplements among individuals with varying causes of anemia.
Methods and Study Design: A random sample of 101 anemic individuals living in Metro
Manila was examined. Hemoglobinopathy was determined using capillary electrophoresis.
Iron deficiency was determined using immunoradiometric assay for serum ferritin. A
questionnaire was used to obtain information on the use of iron supplements. Results: The
most frequent underlying cause of anemia was iron deficiency (37.6%), followed by
anemia due to other causes (34.7%), and hemoglobinopathy (27.8%). The most prevalent
form of hemoglobinopathy was alpha-thalassemia trait (20.8%), followed by
beta-thalassemia trait (5%), iron deficiency anemia with concomitant HbE (1%), and
beta-thalassemia HbE interacting (1%). Thalassemic subjects exhibited mild anemia, had
either normal or excessive iron stores, and did not ingest iron supplements. Conclusion:
The majority of anemia (62.5%) in this sample was due to other causes and
hemoglobinopathy, rather than iron deficiency. Genetic hemoglobin disorders appear to be
common among anemic individuals. Population screening is needed to determine the real
prevalence of the disease. Further investigation is needed to identify other causes of
anemia among Filipinos.

Association of dopamine receptor D2 gene (DRD2) Taq1
polymorphisms with eating behaviors and obesity among
Chinese and Indian Malaysian university students

Abstract:Background and Objectives: This study investigated the association of DRD2 Taq1A,
Taq1B and Taq1D gene polymorphisms with eating behavior, the preference/intake
frequency/craving of high-fat foods and obesity in 394 Malaysian adults (161 males, 233
females; 308 Chinese, 86 Indians; 67 obese, 327 non-obese). Methods and Study Design:
Eating behaviors namely Cognitive Restraint, Uncontrolled Eating and Emotional Eating
scores were assessed by the Three Factor Eating Questionnaire-R18. The preference/intake
frequency/craving of 26 common high-fat Malaysian foods was assessed using a 7-point
hedonic scale. Anthropometric measurements were taken and Taq1 gene polymorphisms
were genotyped by PCR-Restriction Fragment Length Polymorphism using DNA extracted
from mouthwash samples. Results: The overall minor allele frequencies of Taq1A, Taq1B
and Taq1D according to ethnicities (Chinese/Indian) were 0.37/0.29, 0.39/0.28, 0.06/0.30,
respectively; genotype and allele distributions of Taq1B and Taq1D were significantly
different between ethnicities. Eating behavior scores were not significantly different
between gender and ethnicities. Those with A1 or B1 allele had lower Cognitive Restraint
score and higher Uncontrolled Eating score, while those with A1/A1 or B1/B1 genotype
had higher fast food preference. D1 allele was associated with increased starchy food
craving and mamak (Malaysian Indian-Muslim) food preference, but not eating behavior
scores. All three gene variants were not associated with obesity and adiposity.
Conclusion: Taken together, we posit that three DRD2 Taq1 gene polymorphisms
influence the eating behavior and preference/intake frequency/craving of certain high-fat
foods in Malaysian adults, but their role in obesity and adiposity is still inconclusive and
needs further investigation.

Combined effect of eating alone and a poor nutritional status on
cognitive decline among older adults in Taiwan

Abstract:Background and Objectives: Nutritional status is not only associated with older
individuals’ physical health but also has an impact on their cognitive functioning. Evidence
indicates that a socially integrated lifestyle in the later stages of life protects against
cognitive decline and dementia. This study tested the combined effect of two hazards, the
risk of malnutrition and eating meals alone, on the cognitive changes among a
representative sample of older Taiwanese individuals over an 8-year period. Methods and
Study Design: Data were taken from the Taiwan Longitudinal Survey on Aging. In 1999,
2584 respondents aged 65 years were surveyed, and follow-up surveys were performed in
2003 and 2007. The Short Portable Mental Status Questionnaire (SPMSQ) and Mini
Nutritional Assessment were used to evaluate participants’ cognitive functioning and
nutritional status, respectively. Nutritional status and eating alone data assessed at baseline
were combined to predict changes in SPMSQ scores longitudinally. Generalized estimating
equations were used to evaluate the longitudinal changes from baseline to 2007. Results:
Findings suggest that nutritional status was a salient predictor for cognitive decline among
the older Taiwanese adults over the 8-year period. Female respondents who had a
compromised nutritional status at baseline and who were eating their meals alone exhibited
a greater decrease in SPMSQ scores compared with those who had a normal nutritional
status and who were eating their meals with others. Conclusion: Nutritional programs for
the elderly should focus on what they eat as well as who they eat their meals with to
prevent social isolation, especially among older women.

Abstract:Background and Objectives: Methylenetetrahydrofolate reductase (MTHFR) irreversibly converts 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, which is the main form of folate used in the body. Previous studies suggest that MTHFR polymorphism influences folate metabolism, but conflicting results are reported. We performed a meta-analysis to accurately characterize the association between MTHFR A1298C polymorphism and peripheral blood folate concentration in healthy populations. Methods and Study Design: Studies focusing on MTHFR A1298C polymorphism and folate concentrations were identified and subjected to a meta-analysis using Review Manager 5.1. Standard mean differences (SMD) with 95% confidence intervals (95% CI) were used to assess the association between these variables. Results: A total of 14 studies with 5616 healthy individuals were included in this meta-analysis. Significant differences in folate concentration were found in the MTHFR homozygote model (SMD=0.12, 95% CI=0.00-0.24, I2=17%, p=0.04) and the dominant model (SMD=0.07, 95% CI=0.01-0.14, I2=22%, p=0.02) in the general population excluding the elderly. While abnormal folate concentrations are more common in elderly, no association between MTHFR A1298C polymorphism and peripheral blood folate concentration was found in the meta-analysis when elderly were included. Conclusions: This meta-analysis indicates that, in the general population excluding the elderly, the C allele of MTHFR 1298 polymorphism is associated with the risk for an increased folate concentration.

Abstract:Background and Objectives: Zyactinase® is an extract of green kiwifruit, formulated into the consumer healthcare products marketed as Phloe® and Kivia, used to assist in the relief of the symptoms associated with a range of digestive system dysfunction, including constipation and Irritable Bowel Syndrome (IBS). Methods and Study Design: A randomised, doubleblind, placebo-controlled clinical trial was undertaken to determine the effects of the kiwifruit extract on bowel movement, stool formation and IBS associated symptoms amongst a subject group of generally healthy individuals experiencing a period of moderate constipation. Fiftyeight participants were randomized to the kiwifruit extract (28) or placebo (30). Selection criterion was decreased number of bowel movements (<3/week), with increased faecal hardness and IBS associated symptoms. The study ran for three weeks, with participants first undergoing a seven-day wash out period, followed by a seven-day dosing period, and then a seven-day follow up period. Results: There was a significant increase in the defecation frequency (p < 0.001), with a significant improvement in faecal score (p<0.01). There was a significant difference in painful defecation and abdominal pain between the two groups (p<0.01). No side effects, including diarrhoea, urgency or abdominal pain, were observed during the trial. Conclusions: The green kiwifruit extract significantly induced normal bowel movements with no adverse effects. The kiwifruit extract relieved constipation and the symptoms of IBS such as bloating, flatulence and abdominal pain.

Abstract:Background and Objectives: The genetic variations of vitamin D receptor (VDR) have revealed its association with the risk of metabolic syndrome (MetS). In Thailand, evidence of this association has not been obtained. Thus, this study aimed to investigate the association of VDR gene polymorphism with MetS and related diseases as well as the possible linkage disequilibrium (LD) and haplotypes of VDR in Thai adults. Methods and Study Design: Four single nucleotide polymorphisms (SNPs) of VDR gene, rs2228570, rs1544410, rs7975232 and rs731236, were genotyped using PCR-RFLP method in 259 MetS and 261 control groups. Results: Genotypes AA of rs1544410, TG of rs7975232 and TG+TT of rs7975232 were significantly associated with an increased risk of MetS [OR 10.8 (2.07–56.1), p=0.005], [OR 1.83 (1.16–2.87), p=0.009] and [OR 1.78 (1.17–2.72), p=0.007], respectively, using GG as a reference. Moreover, genotype AA of rs1544410 showed a strong association compared with GG+AG [OR 11.4 (2.20–59.2), p=0.004]. Diseases related to MetS also had significant associations with two SNPs of the VDR gene (rs1544410 and rs7975232). In addition, LD among rs1544410, rs7975232 and rs731236 was detected. Haplotype CATT significantly increased the risk of MetS [OR 4.32 (1.32–14.1), p=0.016], although haplotype TGGT reduced the risk [OR 0.68 (0.48–0.98), p=0.042]. Conclusions: The SNPs rs1544410 and rs7975232 were mainly implicated in the increased risk of MetS in the Thai population. LD and haplotypes of VDR gene related to MetS were also discovered. These SNPs of VDR gene are remarkable genetic factors involved in the development of MetS.

Abstract:Background and Objectives: There are few data on the fatty acid status of non-pregnant
Indian women. Our objective was to investigate the effect of a snack containing green
leafy vegetables (GLVs) on women’s erythrocyte long chain polyunsaturated fatty acid
status (LCPUFA). Methods and Study Design: Non-pregnant women (n=222) aged 14-35
years from Mumbaislums were randomized to consume a snack containing GLVs, fruit and
milk (treatment) or a control snack containing foods of low micronutrient content such as
potato and onion, daily under observation. One treatment snack contained a mean (SD) of
54.1 (33.7) mg alpha-linolenic acid (ALA) and one control snack contained 4.1 (3.4) mg
ALA. Blood was collected at baseline (0 weeks) and after 12 weeks of supplementation.
Erythrocyte fatty acids were analyzed using gas chromatography and expressed as g/100g
fatty acids. Plasma malondialdehyde, homocysteine, and erythrocyte superoxide dismutase
and glutathione peroxidase were measured. The effect of the treatment on 12 week
LCPUFA was assessed using ANCOVA models. Results: Median (IQR) erythrocyte DHA
in the treatment group increased from 1.50 (1.11, 2.03) at baseline to 1.86(1.50, 2.43)
(p<0.001) at 12 weeks, and fell in controlsfrom 1.78 (1.37, 2.32) to 1.60 (1.32, 2.04)
(p<0.001). The total n-3 fatty acids increased in the treatment group. There was no effect
on malondialdehyde and antioxidant enzyme levels. Plasma homocysteine at 0 and 12
weeks was inversely associated with erythrocyte DHA at 12 weeks. Conclusion:Daily
consumption of a snack containing GLV improved women’s erythrocyte DHA levels
without increasing oxidative stress

The quality of evidence on nutrition intervention published in Chinese journals: an assessment of meta-analyses on vitamin interventions

Abstract:Background and Objectives: The quality of meta-analyses (MAs) on nutrition intervention in mainland China remains uninvestigated. To assess the quality of the evidence regarding nutrition intervention in mainland China, we used vitamin intervention as an example to assess the overall methodological and reporting qualities of MAs on nutrition interventions published in Chinese journals. Methods and Study Design: A cross-sectional study on MAs of vitamin interventions was performed. Four Chinese databases were searched from inception through September 2016 for all MAs of vitamin intervention. A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to assess methodological and reporting qualities, respectively. Results: A total of 43 MAs of vitamin interventions were included, but none of the studies had been updated. These reviews mainly focused on the effects of interventions involving vitamin D, B vitamins and vitamin E, and the most studied condition was “Endocrine, Nutritional and Metabolic diseases,” such as diabetes, obesity, and nutritional rickets. The median AMSTAR score was 6 (0-7), and median PRISMA score was 18 (3-24). No study provided an ‘a priori’ design, a list of excluded studies, or a statement on conflict of interest, and less than 50.0% of included MAs stated the publication status and performed an adequate structure summary. Conclusions: The quality of the included MAs was disappointing regarding some items, and some lower quality reviews should be updated. Future MAs should improve on reporting conflicts of interest, harm, and publication bias.

Abstract:Background and Objectives: Dietary patterns are undergoing a major shift worldwide. This study analysed the consumption of processed and ultraprocessed foods in Jakarta and its contribution to the energy and nutrient intake based on the Individual Food Consumption Survey 2014. Methods and Study Design: Food consumption data were based on 24-hour dietary recall. Foods were grouped into four food groups: nonprocessed foods, processed ingredients, processed foods, and ultraprocessed foods and subsequently categorised according to the Indonesian Food Category System. Energy and nutrient intake were calculated using Nutrisurvey 2007 software. Results: Nonprocessed food, processed ingredient, processed food, and ultraprocessed food consumption contributed to 57.2%, 21.6%, 1.7%, and 19.5% of total weight consumption, respectively. Ultraprocessed foods contributed to 15.7%, 16.7%, 14.2%, 12.6%, 18.4%, and 31.3% of daily energy, carbohydrate, protein, fat, sodium, and sucrose intake, respectively, and the respective contributions of nonprocessed foods were 52.2%, 58.7%, 65.8%, 32.6%, 7.9%, and 11.1%; of processed ingredients were 30.0%, 22.7%, 16.4%, 53.6%, 68.9%, and 57.6%; and of processed foods were 2.1%, 2.0%, 3.6%, 1.2%, 4.8%, and 0%. Linear regression analysis between the amount of food consumption and nutrient intake showed that at the same weight consumption, processed ingredients provided a higher intake of energy, fat, sodium, and sucrose than the other food groups. Conclusions: Processed and ultraprocessed foods still have a lower contribution to energy and nutrient intake in Jakarta than nonprocessed foods and processed ingredients.

Weight and height faltering in the indigenous children (Orang Asli) of Peninsular Malaysia during the first 2 years of life

Abstract:Background and Objectives: Information on the growth status of indigenous children is useful for developing intervention strategies, but the data are limited. This study determined the prevalence of undernutrition among under-five indigenous children (Orang Asli) and tracked the growth status of Orang Asli children aged 0–3 years. Methods and Study Design: This study had two phases: a cross-sectional growth study of under-five Orang Asli children (N=304; Phase 1) and a 2-year prospective cohort growth study of Orang Asli children aged 0–3 years (N=214; Phase 2) in the Temerloh district of Pahang, Malaysia. Weight-for-age, length/height-for-age, weight-for-length/height, and body mass index-for-age were determined. Results: The prevalence rates of stunting, underweight, wasting, and thinness in under-five Orang Asli children (Phase 1) were 64%, 49%, 14%, and 12%, respectively. In the cohort of 214 children (Phase 2), weight-for-age was initially documented and maintained closely at −1.50 standard deviations (SD) in the first 6 months, but it declined to approximately −2.00 SD at 15 months and remained close to −2.00 SD thereafter. Length/height-for-age declined rapidly to approximately −2.50 SD at 18 months and fluctuated between −2.30 and −2.50 SD thereafter. Weight-for-length/height increased sharply to −0.40 SD at 2–3 months, declined gradually to less than −1.00 SD at 12 months, and plateaued between −1.00 and −1.30 SD thereafter. Conclusions: Undernutrition is prevalent among Orang Asli children, with length rather than weight faltering being more pronounced in the first 2 years of life. Identifying the causes of early growth retardation in this population is required to inform future preventive strategies.

Abstract:Background and Objectives: Hand grip strength (HGS) has emerged as a predictor of the nutritional status. However, many factors may modify the malnutrition–HGS association. This study explored the nutritional assessment value and determinants of HGS in patients hospitalized with cancer. Methods and Study Design: In this multicenter, retrospective, observational study (11,314 patients), the Receiver operator characteristic curve was used to observe HGS and nutritional status sensitivity/specificity. Sex; age; height; weight; mid-upper arm circumference (MAMC); Patient-Generated Subjective Global Assessment (PG-SGA) score; Karnofsky score; physical function (PF) domain; cognitive function (CF) domain; global health and quality of life (QL) domain of EORTC QLQ-C30 (a quality of life instrument designed by the European Organization for Research and Treatment of Cancer); and albumin, prealbumin, and hemoglobin levels were included in a Stepwise analysis model to identify the factors influencing HGS. Results: HGS showed a very low diagnostic value and accuracy for identifying severe malnourishment (area under the curve, 0.615–0.640; p˂0.01). HGS positively correlated with sex; height; weight; MAMC; Karnofsky score; QL, PF, and CF domains; and hemoglobin and prealbumin levels (Beta=0.02–0.42, p≤0.05), and negatively with age (Beta=−0.19, p˂0.01). However, the PG-SGA score was excluded because of its very limited contribution to HGS variability. Conclusions: HGS is a mutifactorial index. The use of HGS cutoff values to identify malnutrition is markedly challenging. Thus, HGS may be of limited use as a predictor of nutritional status

Abstract:Background and Objectives: The association between tea consumption and type 2 diabetes risk remains inconsistent in Asian populations. This case-control study investigated the association between habitual tea consumption and the risk of type 2 diabetes among Vietnamese adults. Methods and Study Design: A hospital-based case-control study was conducted during 2013-2015 in Vietnam. A total of 599 newly diagnosed diabetic cases (aged 40-65 years) and 599 hospital-based controls, frequency matched by age and sex, were recruited. Information about frequency, quantity, and duration of tea drinking, together with demographics, habitual diet and lifestyle characteristics, was obtained from direct interviews using a validated and reliable questionnaire. Unconditional logistic regression analyses were performed to assess the association between different metrics of tea consumption and the type 2 diabetes risk. Results: Control subjects reported higher tea consumption levels than the cases in terms of duration, frequency, and quantity of tea drunk. After accounting for confounding factors, increasing tea consumption was found to be associated with a reduced risk of type 2 diabetes; the adjusted odds ratio (95% confidence interval) was 0.66 (0.49, 0.89) for participants drinking >2 cups/day, relative to those drinking <1 cup/day. Significant inverse dose-response relationships were also observed for average number of cups consumed daily and years of tea drinking (p<0.01). Conclusions: Habitual tea consumption is associated with a reduced risk of type 2 diabetes among Vietnamese adults.

Abstract:Background and Objectives: Nutritional anemia is a significant public health issue with 5080% prevalence in Indian children. Fortification of food, specifically milk, with iron is a potential approach to increase dietary iron intake. Ferric pyrophosphate [Fe4(P2O7)3] is organoleptically neutral and is less soluble in acid medium and, further, has low bioavailability in milk. However, since ascorbic acid is a potent enhancer of iron absorption, the co-administration of ascorbic acid with Fe4(P2O7)3 might enhance the absorption of iron. We evaluated the effect of ascorbic acid on iron absorption from a Fe4(P2O7)3 and an ascorbic acid fortified milk beverage with respect to milk fortified with Fe4(P2O7)3 alone. Methods and Study Design: A double-blind, two-way crossover, randomized study was conducted in 25 mildly anemic children. The test group received milk fortified with beverage powder containing 7 mg isotopically labeled iron (57Fe/58Fe) as Fe4(P2O7)3 , equimolar proportions of ascorbic acid and 200 mg of calcium whereas control group received milk fortified with energy, calcium and iron equivalent beverage powder. Fractional iron absorption was measured by erythrocyte incorporation of stable isotopes of iron (57Fe/58Fe) in both the groups. Results: The fractional iron absorption from the control drink was 0.80% (95% CI: 0.57, 1.12). Fortifying the milk with an equimolar amount of ascorbic acid increased the fractional iron absorption almost 2-fold to 1.58% (95% CI: 1.13, 2.22). Conclusions: The presence of ascorbic acid in an equimolar ratio with that of iron from Fe4(P2O7)3 salt in milk as a fortificant enhanced iron absorption when compared to milk fortified with only Fe4(P2O7)3

Abstract:Background and Objectives: Preschool undernutrition remains a burden in Nepal. This paper reports results of surveys in 2013 and 2014, examining patterns of child nutritional status across the country, associations with household food insecurity and antecedent comparative national data for subsequent evaluations of nutritional status following the earthquake in Nepal in 2015. Methods and Study Design: A multi-stage sample was drawn comprising 21 sites in 75 districts of the country, representing the mountains, hills and Terai zones, providing proportionate to zonal samples of 4286 and 4947 households and 5401 and 5474 preschool children in each year, respectively. Children 6 to 59 months of age were measured for weight and height, expressed as standardized z-scores for height-for-age (HAZ), weight-for-height (WHZ), and stunting and wasting (

Abstract:Background and Objectives: The results of prenatal nutrient supplementation on birth weight are inconsistent in different areas. This study aimed to investigate whether the effects of prenatal iron plus folic acid and folic acid supplementation on neonatal birth weights differed between urban and rural areas of Northwest China. Methods and Study Design: A stratified multistage random sampling method was used to recruit women between the ages of 15 and 49 and their offspring born between 2010 and 2013 from 10 urban areas and 20 rural areas of the Shaanxi Province of Northwest China. Information regarding socio-demographics and prenatal nutrient supplementation status was collected using a standardized questionnaire, and the neonatal birth weights were obtained from the birth certificates. Multilevel models were established separately for the urban and rural areas to assess the effects of prenatal nutrient supplementation on neonatal birth weights. Results: The association between prenatal nutrient supplementation and neonatal birth weight was not statistically significant in urban areas. However, in rural areas, prenatal iron plus folic acid and folic acid supplementation increased the mean birth weights by 45.3 g (9.4 to 81.1 g, p=0.014) and 30.9 g (15.6 to 46.1 g, p<0.001), respectively. Conclusions: The effects of prenatal nutrient supplementation on neonatal birth weights differ between urban and rural areas of Northwest China. The different effects may be due to the different nutritional status of the urban and rural pregnant women. Prenatal nutrient supplementation may be a helpful way for improving neonatal birth weight in rural areas.

Iodine deficiency in women of childbearing age: not bread alone?

Abstract:Background and Objectives: Iodine deficiency remains a public health concern, particularly
in pregnant women and those planning pregnancy because of the risk of impaired fetal
neurological development. Following implementation of strategies to improve iodine intake
in Australia, there has been minimal investigation into current iodine status. We aimed to
characterise iodine status in a population of women of childbearing-age in Australia.
Methods and Study Design: A cross-sectional study was performed in 97 women of
childbearing-age attending outpatient clinics at a tertiary hospital in Sydney. Pregnant and
postmenopausal women were excluded. Iodine intake was surveyed via questionnaire. Spot
urinary iodine (UI) was concurrently measured. The relationships between UI, dietary intake
and use of iodine-containing multivitamins/medications were examined. Results: Median UI
was 117 ug/L. Forty women (41%) were iodine deficient (UI <100 ug/L). The most
commonly consumed source of dietary iodine was bread (29/97, 30% daily). Forty-three
women took iodine-containing multivitamins but 18/43 (41.2%) remained deficient. There
were no significant associations between UI and diet. There was a smaller proportion of
deficient people than in our previous study (125/180 non-pregnant subjects, 69%, vs 41% in
this study, p<0.001). Conclusion: The overall population median is now sufficient, however,
a significant proportion of this multicultural group are iodine deficient. There are similar
proportions of deficiency in those using iodine supplements versus not. Contributors may
include ethnicity-related dietary practices, limited awareness or poor adherence to iodine
supplements. Despite public health strategies, a significant proportion of women of
child-bearing age remained iodine deficient. Further research involving a larger population
and contributors to iodine deficiency is warranted.

Risk factors for parenteral nutrition-dependence and mortality with the short bowel syndrome: a 10-year retrospective study in Thailand

Abstract:Background and Objectives: Short bowel syndrome (SBS) is a rare and life-threatening disease. Few studies have investigated risk factors for parenteral nutrition (PN)-dependence and death in SBS. Accordingly, the aim of this study was to investigate the risk factors for PN-dependence and long-term mortality in SBS. Methods and Study Design: This retrospective study reviewed and evaluated children and adults who were diagnosed with SBS at King Chulalongkorn Memorial Hospital from October 2005 to January 2015. Age, causes of SBS, length of remnant bowel, type of anastomosis, types of nutrition support, SBSassociated complications, PN-dependence rate, duration of PN-dependence, mortality rate, and causes of death were evaluated. Results: Twenty-two adults and 19 children were reviewed. The median follow-up time was 48 months. At the end of follow-up, PNdependence rate was 51.2%. The residual colon ≥50% group had a significantly lower PNdependence rate, with a hazard ratio of 0.36 (95% CI: 0.14-0.93; p=0.03). The most frequent cause of death was infection, with the highest percentage of mortality occurring within the first 2 years after surgery. The mortality rate was 53.8% and the residual colon ≥50% group had a significantly lower mortality rate, with a hazard ratio of 0.36 (95% CI: 0.14-0.88; p=0.03). Conclusions: PN-dependence and death occurred in about half of all patients. Residual colon ≥50% was significantly associated with lower death rate and PN-dependence. The crucial role of colon in continuity as a protective factor should be investigated further in prospective studies.

Accuracy of basal metabolic rate estimated by predictive equations in Japanese with type 2 diabetes

Abstract:Background and Objectives: Estimation of energy demand using basal metabolic rate
(BMR) is a rational approach for optimizing glycemic control and weight management in
patients with type 2 diabetes mellitus (T2DM). Here, we assessed the accuracy of
predictive equations in estimating BMR in Japanese patients with T2DM. Methods and
Study Design: BMR was measured indirectly (BMRm) with a portable gas analyzer in the
fasting state in 69 Japanese patients with T2DM. BMR was estimated using the
Harris-Benedict equation (BMRhb) and Ganpule equation (BMRg). An original predictive
equation (BMRdm) was formulated by stepwise multiple regression analysis using subject
age, lean soft tissue mass, fat mass and bone mineral content. Mean differences and 95%
limits of agreement between measured and three estimated BMRs were evaluated by
Bland-Altman plots. In addition, subjects were divided into three BMI groups (normal,
BMI <25; overweight, BMI ≥25; obese, BMI ≥30), and the influence of BMI on the error
size between measured and estimated BMRs was assessed. Results: Between BMRm and
the three estimated BMRs (BMRhb, BMRg, and BMRdm), there were small systematic
errors with large random errors (mean difference±2SD ; −32±365 kcal，26±405 kcal, and
−1.6±349 kcal, respectively) and significant proportional errors (r=0.42, 0.44, and 0.30,
respectively). BMI subgroup analysis revealed that the obese group showed larger random
errors and significant proportional errors compared to the overweight and normal weight
groups. Conclusion: Predictive equations provide unacceptably inaccurate estimates of
BMR in Japanese patients with T2DM, particularly in obese individuals.

Abstract:Background and Objectives: Childhood obesity is increasing in urban India. This study
aimed to examine the associations of younger siblings abdominal adiposity with individual,
familial and environmental factors, in urban school aged siblings. Methods and Study
Design: Weight, height and waist circumference of 2906 siblings aged 3-16 years were
measured along with details on demographics, diet, lifestyle, behavior and reported
parental anthropometrics. Abdominal adiposity was classified as waist circumference
above the age and sex specific 75th percentile value. The associations of various factors
with abdominal adiposity in the younger siblings were examined through logistic
regression analyses. Results: Sibling, familial factors and environmental factors had
significant associations with abdominal adiposity. The odds of a younger sibling having
abdominal adiposity was greatest (OR=3.16, 95% confidence interval (95% CI): 2.27 to
4.42), when the older sibling had abdominal adiposity, followed by the odds ratio of both
parents being overweight (OR=1.63, 95% CI: 1.33 to 1.99) compared to neither being
overweight. The influence of abdominal adiposity of the older sibling was greater when the
siblings were of the same sex (OR=3.53, 95% CI: 2.22 to 5.60) than when they were of
different sex (OR=2.73, 95% CI: 1.67 to 4.46); the odds ratio being highest when both
siblings were males. Conclusions: The younger sibling’s abdominal obesity is associated
with that of his/her sibling and parental obesity, in addition to other known risk factors in
urban south Indian families. Interventions to prevent childhood obesity need to also
consider the sibling effect along with the other known factors.

Comparison of effectiveness, safety, and costs of standardized
and customized parenteral nutrition support among gastric
cancer patients after gastrectomy: a retrospective cohort study

Abstract:Background and Objectives: To compare the effectiveness, safety, and costs of
commercial standardized multi-chamber bag and customized compounded total parenteral
nutrition (TPN) among gastric cancer patients after gastrectomy. Methods and Study
Design: A retrospective cohort study was conducted among 64 gastric cancer patients who
underwent gastrectomy from 2014 to 2016 in a tertiary teaching hospital in Beijing, China.
Patients were categorized into standardized (s-TPN) and customized TPN (c-TPN) groups
based on their TPN order after gastrectomy. Patients were followed up until discharge. The
effectiveness measures (body mass index (BMI) and albumin) and safety measures (liver
and renal functions and electrolytes) were compared before TPN started and after TPN
finished within and between the two groups. The length of hospital stay and costs were
compared between the two groups. Results: There were no significant differences between
the two groups in BMI preservation, metabolic complications, the length of hospital stay
and costs, except that both total bilirubin (Tbil) and direct bilirubin (Dbil) were
significantly higher in the s-TPN group than c-TPN (p<0.05). Conclusions: There were no
significant differences in effectiveness and safety measures, the length of hospital stay and
costs between s-TPN and c-TPN groups, except that s-TPN group was more likely to lead
to parenteral nutrition-associated liver disease (PNALD). More studies are needed to
confirm the findings of this study in other healthcare settings and study populations.

Association between metabolic syndrome and coffee
consumption in the Korean population by gender: a
cross-sectional study in Korea

Abstract:Background and Objectives: We conducted this cross-sectional study to identify the
association between coffee consumption and risk of metabolic syndrome (MetS) in the
Korean population. Methods and Study Design: Subjects aged 30–79 years in the Fifth
Korea National Health and Nutrition Examination Survey conducted in 2010 and 2011
were included (n=8,246). The self-reported frequency of coffee consumption was classified
as non-drinker, <1, 1, 2, and ≥3 cups/day. Results: The MetS prevalence was 33.6% in
men (n=1,149) and 26.1% in women (n=1,388). Among women, the level of coffee
consumption was inversely associated with MetS and each component (p for trend 0.002
for abdominal obesity and <0.001 for others). The dose-response inverse association
remained significant between coffee consumption and MetS, high triglyceride, and low
high-density lipoprotein cholesterol (p for trend 0.001, 0.009, and <0.001, respectively;
adjusted for age and body mass index). Compared with women who did not consume
coffee, the adjusted odds ratio (OR) for MetS was 0.57 (95% CI, 0.38–0.86) for women
who consumed ≥3 cups per day (p for trend 0.002). Among women, excluding those
receiving medical treatments for hypertension, diabetes, and dyslipidemia, a significantly
lower OR for MetS (0.53, 95% CI 0.31–0.93) was observed with coffee consumption ≥3
cups, and the dose-response inverse association remained significant (p for trend 0.008). In
men, there were no significant associations between coffee consumption and MetS.
Conclusion: In conclusion, coffee consumption is associated with a lower risk of MetS
among Korean women. There was a dose-response inverse relationship between coffee
consumption and the prevalence of MetS in Korean women.

Comparative validity of a Food Frequency Questionnaire
(MyUM Adolescent FFQ) to estimate the habitual dietary intake
of adolescents in Malaysia

Abstract:Background and Objectives: The food frequency questionnaire (FFQ) is a dietary tool
used to assess the habitual intake of the population. The goal of this study is to examine the
reproducibility and validity of the FFQ that was developed for a multi-ethnic population in
Malaysia. Methods and study design: Collective food data from MyHeARTs 2012
database were used to construct the MyUM Adolescent FFQ. Seventy-eight participants
between 13 and 15 years old in 2014 were selected through convenient sampling for test –
retest study. They completed the MyUM Adolescent FFQ twice, with an interval period of
one week. One hundred and fifty-six MyHeARTs study participants who were 15 years old
in 2014 were randomly selected for this comparative validity study. They completed a
7-day diet history (7DDH) and subsequently completed the self-administered MyUM
Adolescent FFQ. Results: Pearson’s correlations between the FFQ and 7DDH for all
macronutrients were statistically significant. Energy-adjusted correlations for protein,
carbohydrate, and fat were 0.54, 0.63 and 0.49 respectively. Most of the micronutrients and
minerals, were statistically correlated ranging from 0.31 to 0.49 after energy adjustment.
Cross-classification analyses revealed that more than 70 percent of adolescents were
classified into either the same or adjacent quartile of nutrient intake when comparing data
of 7DDH and FFQ. No serious systematic bias was evident in the Bland-Altman plots.
Conclusion: The 200-item FFQ developed for Malaysian adolescents has moderate to
good comparative validity for assessment of macronutrient and micronutrient intake.

Abstract:Background and Objectives: Coronary artery disease (CAD) is a major cause of death
worldwide. Chronic stable angina (CSA) is the primary sign of CAD. Oxidative stress and
inflammation play a substantial role in pathogenesis and progression of CAD. The aim of
this study was to investigate the effects of oral administration of powdered Melissa
officinalis (MO) on biomarkers of oxidative stress, inflammation, and lipid profile in
patients with CSA. Methods and Study Design: A randomized, double-blind,
placebo-controlled clinical trial was performed in 80 patients with CSA. The subjects were
randomly assigned to obtain either oral MO 3 g/d (n=40) or placebo (n=40) for eight weeks.
Anthropometric indices, biomarkers of oxidative stress, inflammation, and lipid profile
were evaluated at baseline and post-intervention. Results: The mean serum concentrations
of triglycerides, total-cholesterol, LDL-cholesterol, and malondialdehyde (MDA), and high
sensitive C-Reactive Protein (hs-CRP) were lower in the intervention group compared with
placebo (p<0.01) post intervention. Moreover, the mean serum concentration of
paraxonase 1 (PNO1) and HDL-c were higher (p<0.001) in the intervention group
compared with the control group. Conclusion: Oral MO supplementation improves the
lipid profile, MDA, hs-CRP, and PNO1 in patients with CSA.

Abstract:Background and Objectives: Pregnant women are at particular risk of iodine deficiency
due to their higher iodine requirements, however although Iodine is known to be essential
for normal growth and brain development, therefore neonatal outcomes in mildly iodine
deficient areas are a critical consideration. This study aimed to investigate whether iodine
supplement use corresponded to prevention of iodine insufficiency in the neonate using
neonatal TSH screening criteria. Methods and Study Design: Gippsland-based women
aged 18 years, in their third trimester of pregnancy, provided self-reported information
regarding their iodine supplement use and consent to access their offspring’s neonatal
thyroid stimulating hormone (TSH) screening data. 126 women consented to participate,
with 111 women completing all components of this study. Results: Only 18.9% of
participants followed the NHMRC recommendation of 150 µg/day iodine supplement.
With 42.3% of participants not taking any supplements, or taking supplements with no
iodine or insufficient iodine. The remaining women (38.7%) were taking supplements with
doses of iodine much higher (200-300 µg) than the NHMRC recommended dose or were
taking multiple supplements containing iodine. When correlating iodine intake to their
neonates’ TSH, no correlation was found. When iodine supplementation usage was
categorised as below, equal to, or above NHMRC recommendations there was no
significant difference in neonatal TSH. Conclusion: Despite NHMRC guidelines for
iodine supplementation during pregnancy, many women were not taking the required
iodine supplementation. However, the level of maternal iodine supplementation did not
impact on their baby’s neonatal TSH.

Abstract:Background and Objectives: The elderly population is increasing rapidly worldwide, and frailty is a common geriatric syndrome. Comprehensive dietary management strategies may have beneficial effects on frailty prevention and reversal. This 3-month single-blind, paralleled, randomized controlled trial compared the effects of micronutrients and/or protein supplements, and a personalised diet on frailty status in elderly individuals. Methods and Study Design: Between 2014 and 2015, 40 prefrail or frail subjects aged ≥65 years were recruited at Miaoli General Hospital, Taiwan. Of these, 37 completed the study, and 36 were included in the analysis. Participants were randomly assigned to one of four treatment groups: (1) the control (2) multiple micronutrient supplements, (3) multiple micronutrients plus isolated soy protein supplement, and (4) individualised nutrition education with customised dishware and food supplements (mixed nuts and skimmed milk powder). Dietary intake, protein biomarkers, frailty score, and geriatric depression score were assessed. Results: Individualised nutrition education with customised dishware and food supplements significantly increased the participants’ intake of vegetables, dairy, and nuts, in addition to increasing the concentration of urinary urea nitrogen. It yielded a significant reduction in frailty score (p<0.05) and a borderline reduction (p=0.063) in geriatric depression score. No significant beneficial changes were observed for the other two intervention groups. Conclusions: Our study indicated that a dietary approach with easy-to-comprehend dishware and food supplements to optimize the distribution of the consumption of six food groups improved frailty status and, potentially, psychological well-being in elderly people

Abstract:Background and Objectives: This study investigated the updated prevalence of metabolic syndrome among adults in West China and the influence of diet and behaviour on metabolic syndrome. Methods and Study Design: A cross-sectional survey was conducted from 20132014, and multi-stage stratified clustering sampling was applied in 12 counties of Sichuan province. Data regarding metabolic syndrome and style risk factors were collected through interviewer-administered questionnaires, and physical measurements were recorded following a standardized protocol. Logistic regression models were used to explore the association between metabolic syndrome and its risk factors. Results: A total of 7,131 adults participated. The prevalence of metabolic syndrome was 16.9% and 23.8% according to the International Diabetes Federation criteria and the consensus definition, respectively. The International Diabetes Federation criteria failed to identify 28.8% of the participants identified by the consensus definition. The odds ratios (ORs) of suffering from Metabolic syndrome in people eating pork every week compared with at lower frequencies, people eating more than 100 g of red meat/day, people with more sedentary behaviour per day, and people consuming at least 20 cigarettes/day were 1.76 (1.09-2.84), 1.28 (1.01-1.62), 1.03 (0.99-1.07), and 1.46 (1.121.92), respectively, according to the consensus definition, and 1.51 (1.09-2.10), 1.4 (1.141.72), 1.07 (1.02-1.13), and 1.5 (1.16-1.94), respectively, based on the International Diabetes Federation criteria. Conclusions: The International Diabetes Federation criteria were less sensitive in identifying metabolic syndrome than the consensus definition. More sedentary behaviour, smoking ≥20 cigarettes per day, and a higher frequency of pork intake increased the risk of metabolic syndrome in this study.

Nutritional outcomes with radiotherapy for head and neck cancer: a before and after comparison of ‘best practice guidelines’ implementation

Abstract:Background and Objectives: Malnutrition is prevalent amongst people with head and neck cancer treated with radiotherapy and can result in reduced tolerance to treatment and increased hospital admissions. Current best-practice guidelines recommend weekly dietetic review during radiotherapy and fortnightly review for six weeks following radiotherapy to minimize weight loss. The primary aim of this study was to compare percent weight loss during radiotherapy before and after the implementation of weekly dietetic review. In the post-guideline implementation group we aimed to investigate factors associated with greater weight loss and describe weight changes 4-8 weeks post radiotherapy. Methods and Study Design: Adults with head and neck cancer who received dietetic input and curative intent radiotherapy were included. Data were collected via retrospective chart audit of records from the Nutrition and Dietetics department. Results: The analysis involved 142 people, 66% (n=94) of whom received dietetic input in the post-guideline implementation period. Mean weight loss was not different between the pre- and post-guideline implementation groups (5.9±6.34% vs -6.6±5.29%; p=0.477). In the post-guideline implementation group, advanced tumor stage and concurrent chemoradiation were associated with greater percent weight loss (p=0.006 and p<0.001, respectively). Mean weight loss increased by 1.9±4.96%, 4-8 weeks after radiotherapy (p=0.004). Conclusions: Percent weight loss during radiotherapy was not reduced following the implementation of weekly dietetic review. In the 4-8 weeks following radiotherapy, weight loss increased significantly over that between baseline and end of radiotherapy. Future research should explore and address the reasons why critical weight loss occurs despite improved access to dietetic care.

A dietary and nutritional status survey among young children in five big cities of China

Abstract:Background and Objectives: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. Methods and Study Design: A crosssectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical examination, blood hemoglobin measurements and a 24 hour dietary recall questionnaire. Results: The educational level of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient deficiencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6 - 11 and 12 - 23 month old children. 3.) An increased risk of overweight/obesity. Conclusions: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further improvements in the diet and nutrition of young children in these environments is likely require more specific education to parents and other significant carers such as grandparents. The relatively high educational level and socio-economic status of the population group is likely to facilitate the uptake of such measures in this population group.

Is high sodium intake associated with hearing impairment? The
association between spot urine sodium concentration and
hearing threshold in Korean adolescents

Abstract:Background and Objectives: High sodium intake is a well-known risk factor for diseases
such as cardiovascular and renal disease. There may also be links between sodium intake
and inner ear symptoms. However, the available data are limited, and clinicians remain
suspicious about sodium intake and hearing threshold. We analyzed the relationship
between spot urine sodium concentration and sensorineural hearing loss in Korean
adolescents. Methods and Study Design: A total of 534 subjects, aged 12–19 years old,
were enrolled in this study. Sex, age, hearing threshold, and overnight spot urine sodium
concentration were measured. Multivariate logistic regression analysis was performed to
estimate the independent effect of sodium intake on hearing level. Results: Higher urine
sodium concentrations were observed in subjects with hearing impairment in 2000, 3000
and 4000 Hz. After adjusting for sex, age and BMI, we found an association between urine
sodium concentration and sensorineural hearing loss in 500, 2000, 3000 and 4000 Hz.
Conclusion: Our results suggest that high sodium intake might be associated with hearing
impairment.

Abstract:Background and Objectives: Persistent diarrhea has been proven to cause pancreatic
exocrine insufficiency, due to decreased stimulation to the pancreas caused by prolonged
mucosal injury. Pancreatic enzyme replacement therapy (PERT) given in conjunction to
regular treatment is thought to be beneficial in replacing this pancreatic enzyme deficiency,
avoiding the need of elemental diet. This study aims to evaluate the benefit of PERT in
children with persistent diarrhea. Methods and Study Design: This is a randomized, two
double-blind parallel group, placebo-controlled clinical trial to evaluate the effects of
pancreatic enzyme supplementation in persistent diarrhea. Children age 6-60 months were
recruited from pediatric inpatient and outpatient units of five hospitals in Jakarta. Subjects
was randomly assigned to either pancreatic enzyme 8371 USP unit of lipase or placebo, 3
times daily for 1 month, as an adjunctive therapy to standard treatment. Subjects were then
reevaluated at 2 weeks and 4 weeks interval after administration of enzyme or placebo.
Variables observed were length of diarrhea after the start of intervention, change in serum
prealbumin, and change in FE-1 between week 0 and week 4. Results: Pancreatic enzyme
supplementation shortens the length of diarrhea by 7 days in the intervention group
compared to placebo (p=0.019). Serum prealbumin and FE-1 shows trend that favors the
intervention group, although not statistically significant (p>0.05). Conclusion: PERT is
clinically effective in reducing the length of diarrhea, thus minimizing the need,
accessibility and costs of an elemental diet.

Anthropometry to assess body fat in Indonesian adults

Abstract:Background and Objectives: Anthropometric equations are widely used to estimate body
composition however, are only appropriate for use in populations in which they have been
developed and validated. The present study developed anthropometric prediction equations
for Indonesian adults and cross-validated them with selected equations used in this population.
Methods and Study Design: Six hundred Indonesian adults aged between 18–65 years (292
males and 308 females) were divided equally into development and validation groups. Stature,
body weight, skinfold thickness at eight sites, girth at five sites, and bone breadth at four sites
were measured. Stepwise multiple regression analysis was used to propose percentage body
fat (%BF) prediction equations using measured variables and %BF from the deuterium oxide
dilution technique as the reference. The proposed prediction equations were then
cross-validated using the validation group and %BF estimated from several existing
equations. Results: Proposed prediction equations showed r ranged from 0.82 to 0.86 and
Standard Error of the Estimate (SEE) from 4.7 to 5.4%. Cross-validation analysis showed
bias with the reference %BF between 0.2 and 3.3% and Pure Error (PE) between 2.8 and
4.0%. Among the existing equations, the Durnin and Womersley equation was applicable in
females whilst the equation by Davidson et al. underestimated %BF by 6.3–6.6% and the
equation by Gurrici et al overestimated by 2.0–3.4% in both genders (p<0.01). Conclusion:
The proposed prediction equations provide better options for accurate prediction of %BF in
Indonesian adults.

Food Guide Pagoda and the food safety of women: one-year
follow-up study on the effects of the 2008 Sichuan Earthquake

Abstract:Background and Objectives: Women are a dominant force in the family’s diet and
nutrition in China. The short-term effects of the 2008 Sichuan Earthquake were found.
However, the long-term effects of the 2008 Sichuan Earthquake on the food safety, energy,
and intake frequency of women remain unclear. This study analyzed the effects of the 2008
Sichuan Earthquake on the dietary behaviors of women one year after the earthquake.
Methods and Study Design: In this cross-sectional study, a total of 207 women were
selected using the proportional sampling method. Among them, 91 were from the
earthquake-affected area and 116 from the non-affected area. Results: Women from the
earthquake-affected area paid significantly more attention to health, diet, and food and
water safety after the earthquake (p<0.05 for each category) when compared with those
from the non-affected area. Women from the earthquake-affected area also had a
significantly higher proportion of adequate understanding of low-energy food, properly
separated their raw food from cooked food, ate high-energy food, and picky eating habits
p<0.05 for each category) than those from the non-affected area. In addition, women from
the earthquake-affected area were more likely to adhere to the 2007 Chinese Food Guide
Pagoda guidelines for eating rice than those from the non-affected area (OR=2.25, 95% CI
[1.13, 4.51]). Conclusion: The female survivors of the 2008 Sichuan Earthquake preferred
high-energy food, paid more attention to food safety, and were more likely to adhere to
FGP when compared to those that did not undergo the same tragedy.

Vitamin A nutrition among East Timor refugee children

Abstract:Background and Objectives: Children age 6 to 72 months, living in refugee camps are at
increased risk of developing vitamin A deficiency (VAD), resulting in increased morbidity
and mortality. Due to poverty, often this population group has limited access to foods
containing vitamin A from animal-based food sources and do not commonly consume
available foods containing beta-carotene. To date, there is a paucity of data on vitamin A
intake in young refugee children. To determine vitamin A intake in children ages 6 to 72
months at refugee camps in East Timor. Methods and Study Design: A cross sectional
study was carried out among children ages 6 to 72 months at refugee camps near Dili, East
Timor. A detailed vitamin A intake questionnaire was ascertained from the primary
caretaker, and the criteria and indicator cut off values suggested by World Health
Organization (WHO) were used to classify the populations’ vitamin A risk. Results:
Although animal sources of vitamin A were limited due to costs, all 89 children commonly
consumed fruit containing vitamin A sources more than 3 times a week. Most children
(69.7%) had been breast fed regularly, while 30.3% combined with bottle milk. 80.9% of
children received vitamin A supplementation. Conclusion: Children in East Timor refugee
camps have adequate vitamin A intake.

Abstract:Background and Objectives: Excessive gestational weight gain has been associated with
higher risk for large for gestational age newborns. This systematic review and
meta-analysis aims to assess whether an intensive diet and exercise intervention has an
effect in reducing gestational weight gain and large for gestational age newborns. Methods
and Study Design: The search was conducted on PubMed and Cochrane database.
Through PRISMA flow diagram, clinical trials which met the including criteria were
selected. Risk of bias, sensitivity analysis, and quality of evidence assessment were
conducted using adequate statistical tests, and the quality of evidence was performed by
GRADE method. A random-effect model was used to estimate the statistical significance
of the meta-analysis. Results: Ten clinical trials met the inclusion criteria. Using the
random-effect model and a sensitivity analysis, it was found that an intensive
patient-centered intervention reduced gestational weight gain when compared with
standard prenatal care (Z=6.21 (p<0.00001); Tau²=0.00; Chi²=3.90, df=4 (p=0.42); I²=0%),
and the quality of evidence was moderate. An intensive diet and exercise intervention
decreased the number of large for gestational age newborns (Z=2.20(p=0.03); Tau²=0.14;
Chi²=7.84, df=4 (p=0.10); I²=49%), and the quality of evidence using the GRADE
approach was moderate. Conclusion: The present review and meta-analysis indicates that
an intensive diet and exercise intervention reduced gestational weight gain and large for
gestational age newborns.

Abstract:Background and Objectives: To determine how frequently diabetic diets are
recommended to individuals with diabetes in South Asia, whether they are followed, and if
they are associated with healthier dietary choices and clinical benefits. Methods and
Study Design: Data are from the Centre for cArdiometabolic Risk Reduction in
South-Asia Cohort Study. Participants with self-reported physician-diagnosed diabetes
(n=1849) were divided into four groups based on whether they reported being prescribed
and/or following a diabetic diet. Linear regression was used to estimate associations
between these groups and outcomes. Results: 53% of participants with self-reported
diabetes reported not being prescribed or following a diabetic diet. Among those
prescribed and following a diet, mean whole grain consumption was 1.18 times/day and
refined grain consumption was 0.75 times/day compared to 0.88 times/day and 1.74
times/day, respectively, among those neither prescribed nor following a diet (both
p<0.0001). Following a diet despite not being prescribed a diet was not associated with
glycemic control, blood pressure, or body mass index, but was associated with a -8.5
mg/dL (95% confidence interval: -15.5, -1.6) lower low-density lipoprotein cholesterol
compared to not following and not being prescribed a diet after adjustment for confounders.
Conclusion: Though participants who were prescribed diabetic diets and followed them
exhibited healthier dietary choices, the majority of participants with diabetes in urban
South Asia was neither prescribed nor followed such diets. Moreover, there was no
statistically significant clinical benefit, thus indicating that current dietary modifications
may not be large enough or consistent enough to produce meaningful changes in health
outcomes in this population.

Abstract:Background and Objectives: The excessive intake of trans fatty acids increases serum
low-density lipoprotein-cholesterol and reduces high-density lipoprotein-cholesterol. We
studied the effects of 1% energy trans fatty acid supplementation on serum lipid
concentrations in healthy adult Japanese with different obesity-related gene
polymorphisms. Methods and Study Design: A randomized, double-blind, parallel trial
was conducted in 53 healthy adults. The volunteers consumed one cookie containing either
1% energy or <0.01% energy (control) of trans fatty acids every day for 4 weeks, and a
blood sample was then obtained after overnight fasting. The single nucleotide
polymorphisms of the fat mass- and obesity-associated gene rs9939609 and beta-3
adrenergic receptor rs4994 were genotyped. Results: The mean trans fatty acid intake of
the control and trans fatty acid groups corresponded to 0.28% and 1.31 % energy,
respectively. There were no significant differences in serum cholesterol (total, low-density
lipoprotein and high-density lipoprotein) or triacylglycerol between the control and trans
fatty acid groups. The responses of serum cholesterol, triacylglycerol, glucose, insulin and
hemoglobin A1c were also independent of the fat mass- and obesity-associated gene and
beta-3 adrenergic receptor gene variants. Conclusions: Our findings indicate that
supplementation with 1% energy trans fatty acids has little effect on serum cholesterol in
healthy adult Japanese, regardless of genotype of fat mass- and obesity-associated gene or
beta-3 adrenergic receptor. More systematic studies, with respect to dietary trans fatty acid
intakes above those used here, may be warranted to determine the tolerable upper level of
dietary trans fatty acid.